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Selective unilateral lung ventilation in preterm infants with acquired bullous emphysema: a series of nine cases
André Jakob1, Christian Bender, Matthias Henschen
1Department of Pediatric Cardiology, University Hospital of Freiburg, Freiburg, Germany. andre.jakob@uniklinik-freiburg.de
Insights
Selective one-sided lung ventilation effectively treated acquired bullous emphysema (BE) in preterm infants. This approach resolved lung overdistension, avoiding surgery and offering a feasible therapeutic option.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Immature lungs of preterm infants are susceptible to overdistension from mechanical ventilation, potentially leading to localized pulmonary emphysema (PE).
- Conventional therapies for PE, particularly bullous emphysema (BE), may be insufficient, sometimes necessitating invasive surgical resection.
- Selective one-sided lung ventilation has emerged as a therapeutic option for acquired BE in neonates.
Purpose of the Study:
- To evaluate the efficacy and feasibility of selective one-sided lung ventilation in preterm infants with acquired bullous emphysema (BE).
- To assess the resolution of BE and associated lung conditions following this intervention.
Main Methods:
- Retrospective review of medical charts of preterm infants (born 1993-2010) with acquired BE treated with selective one-sided ventilation.
- Data collected included gestational age, clinical presentation, disease course, treatments, ventilation duration, and outcomes.
- Therapy success was defined by permanent resolution of BE on chest X-ray and acceptable lung appearance for Bronchopulmonary Dysplasia (BPD).
Main Results:
- Nine preterm infants (24-35 weeks gestation) with acquired BE underwent selective one-sided lung ventilation.
- The intervention lasted 24 hours to 7 days, initiated between postnatal days 12 and 35.
- Therapy was successful in seven patients, with no recurrence of BE, and was technically feasible despite challenges, especially with left-sided intubation.
Conclusions:
- Selective one-sided intubation, though technically challenging, is a feasible and potentially beneficial treatment for acquired bullous emphysema in preterm infants.
- Achieving complete atelectasis of the affected lung lobe for over 48 hours during selective intubation may lead to permanent resolution of airway overdistension.
Background And Aims:
Immature lungs of preterm infants are particularly prone to overdistension from mechanical ventilation or continuous positive airway pressure. In these infants a localized pulmonary emphysema (PE) can develop. Conventional therapy regimens to resolve this process sometimes fail and especially in the case of bullous emphysema (BE) invasive procedures such as surgical resection of the affected lobe ultimately may be required. In the past few years we have applied selective one-sided lung ventilation, a nearly forgotten therapeutic option, in these infants with acquired BE.
Methods:
Medical charts of preterm infants in two Divisions of Neonatology, born between 1993 and 2010 with acquired BE treated with selective one-sided ventilation were reviewed. Gestational age, clinical presentation, course of disease, associated treatment, duration of ventilation and outcome of one-sided lung ventilation are recorded. Therapy was deemed successful if thereafter chest X-ray showed a permanent resolution of the BE and, in case of BPD, lung appearance was comparable to a grade < III according to Weinstein [Weinstein et al. Pediatr Pulmonol 1994; 18: 284-289].
Results:
Overall, nine preterm infants with a gestational age between 24 and 35 weeks and a birth weight between 500 and 3,170 g underwent one-sided lung ventilation. This intervention was started between day 12 and day 35 after birth and was continued for 24 hr to 7 days. In three cases selective intubation was performed on the left side. Two patients needed a second course of one-sided ventilation and one had three courses. Therapy was successful in seven patients, who had no recurrence of BE.
Conclusions:
Selective one-sided intubation is technically challenging, in particular for the left bronchus, but seems to be feasible and helpful. If during selective intubation the affected lung lobe shows complete atelectasis for more than 48 hr the overdistension of airways probably will permanently resolve.
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